Emerging evidence suggests anesthetic agents may influence tumor biology and micrometastasis in lung cancer patients, as the perioperative period represents a vulnerable window during which surgical stress suppresses antitumor immunity and may facilitate disease progression. This narrative review synthesizes mechanistic and clinical evidence on anesthetic management and lung cancer prognosis. Preclinical studies demonstrate biological plausibility: propofol inhibits lung cancer proliferation via the miR-21/PTEN/AKT pathway, while volatile anesthetics may promote progression through HIF-1α upregulation. However, high-quality clinical evidence does not support these findings the GA-CARES trial (n=1,766) showed propofol-based anesthesia does not improve outcomes compared to volatile anesthetics (HR 1.16; 95% CI 0.96-1.41), and large registry studies similarly show no survival benefit. Meta-analyses suggest opioid use is associated with worse outcomes in patients receiving immune checkpoint inhibitors, though confounding remains problematic. Lung cancer patients frequently present with COPD and obesity, which influence anesthetic selection; however, no studies examine whether comorbidity-tailored protocols affect oncologic outcomes representing a critical gap for future research.
